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  • Ssa-795 2020

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Form Approved OMB No. 0960-0045 Social Security Administration STATEMENT OF CLAIMANT OR OTHER PERSON Name of Wage Earner Self-employed Person or SSI Claimant Name of Person Making Statement If other than above wage earner self-employed person or SSI claimant Relationship to Wage Earner Self-Employed Person or SSI Claimant Understanding that this statement is for the use of the Social Security Administration I hereby certify that - Form SSA-795 09-2015 ef 09-2015 Destroy Prior Editions I declare under penalty of perjury that I have examined all the information on this form and on any accompanying statements or forms and it is true and correct to the best of my knowledge. I understand that anyone who knowingly gives a false statement about a material fact in this information or causes someone else to do so commits a crime and may be subject to a fine or imprisonment. SIGNATURE OF PERSON MAKING STATEMENT Signature First name middle initial last name Write in ink Date Month day year Teleph....

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
SSA-795
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